乙卯冬初，余挈眷回籍，卜居 溪。秀水吕君慎庵邀余游新塍，视屠舜传之女适张氏者。据云病起产后，延
已五年，久卧于床，势成瘫痪，广服补剂，迄不见功。及入室视之，病者尚着单衣，贴身仅铺草席，而窗户尽扃。
因询畏热而喜暗乎？曰然。按脉弦而滑，执烛照之，面有赤色，苔甚黄腻。复询其胸闷气升乎？溲热易汗乎？亦
曰然。且汛事仍行，饥不能食，耳鸣头晕，腿软痰多。病不在于血分，虽起自产后，而根株实不在是。细诘之，
始云未嫁之前，宿有气升眩晕之疾，于今已十载矣。余曰是也，此固风阳内炽，搏液成痰之证，因娩而血大去，
故发之较剧，医者不揣其本而齐其末，遂以为产后之虚，温补率投，升逆愈甚，下虚上实，致不能行。与清火降
痰之剂而别。曰气得下趋，病可渐愈。后闻其西席钟君子安向慎庵云∶服王药五帖，即能扶杖以出矣。
舜传之舅嫂，因用力拔针而患指痛，内外杂治，渐至痛遍一身，卧榻不起，食少形消。余诊之，脉细而数，
口干舌绛。乃营阴大亏，无以营养筋骨。岂可因拔针起病，遂以为外伤而妄投燥烈之药乎？宜其病日以甚也。以
集灵膏加减为方而愈。
谢君再华之室，偶患齿痛，日以加甚，至第五日，知余游武林，拉往视之，已呻吟欲绝，浑身肉颤，按脉不
能准，问病不能答，苔色不能察，惟欲以冷器贴痛处。余谛思良久，令以
淡盐汤下滋肾丸三钱；外以坎宫锭涂痛外、吴茱萸末醋调贴涌泉穴。次日复诊，已谈笑自若，如常作针黹矣。向
余致谢曰∶昨药一饮即寐，而病如失，真仙丹也。余谓昨日大窘，若非素知为肝阳内炽之体，几无措手。今火虽
降，脉尚弦数，宜用滋潜善后。以一贯煎方，嘱其熬膏服之，遂不复发。
仁和邵位西枢部令嫒字许子双司马为媳者，在都患心悸头晕，渐不起榻，驯致不能出语。旋杭，多医治之，
佥以为虚，广服补剂，遂减餐少寐，频吐痰涎，畏风怕烦，溲短便闭，汛愆带盛，以为不能过冬至矣。适余游武
林，赵君菊斋嘱其邀诊。脉之弦数而滑，面白唇红，目光炯炯而眉蹙羞明，苔黄乳裂，既非喑证，又非失音，强
使出一、二字，则艰涩异常，摇手点头，或以笔代口，且无妄见，亦非祟病。余谛审之，谓其必起于惊恐，而痰
涎阻于窍隧。病者颔之。以起病时为一大瓶堕地，乍闻其声而一吓也。遂与清心肝胆胃之法，加舒络涤痰开郁之
品。服后各恙渐减，眠食渐安。丙辰春，余复视之。仍卧于床，仍不出语。按钮氏《续觚剩》鼠魂一条，与此相
似，彼特神其说耳。然余竟不能治之使语，殊深抱愧，录之以质高明。戊午季秋，复游武林往诊，尚如故。闻其
仍服补剂，因力劝阻，而赠以清肺通络涤痰之品，制丸噙化。服至次年春仲，遍身发疹，频吐秽痰，语能渐出，
乃蕴结外解，从此整肃，可期奏绩，初论尚不甚爽。
丙辰春初，余游梅泾，曹霭山茂才拉视其令郎之证。云起于往夏疟后，暮热鼻衄，善欠羞明，额颊时 ，溲
混有脚。先禀素弱，佥虑成劳，频服滋填，毫无寸效，久不起榻。及余诊之，脉软滑而微长，苔淡黄而不渴，仅
能仰卧，反侧不能。曰
此非虚劳也，乃热伏阳明，是以机关不利，筋骨不束，而见以上诸证。幸衄血频流，小溲混浊，热气尚有宣泄，
而人不甚枯削，以阳明为多气多血之经也。与生槐蕊、知、柏、芩、栀、白薇、花粉、茅根、茹、斛、丝瓜络等
药，久服果渐愈。
里中张君雪沂令正，三十七岁。于乙巳年患经行腹痛，医进胶艾汤多剂，痛乃日盛，而加以呕吐，迄今十载，
诸药备尝。迩年经至益频，痛势益剧，满床乱滚，声彻比邻。乞余诊之，脉弦滑而数。曰∶巅痛、口渴乎？带多、
腰痛乎？汛色紫黑乎？病者惊以为神，惨容为之一展。余谓雪沂曰∶此证不但温燥腻补不可用，即四物汤亦在禁
例。宜乎遍访女科，而竟无一效也。与芩、连、栀、胆、茹、柏、蒿、薇、乌 、茅根、藕为剂，服至下月经行，
即不吐，痛亦大减。此等药服逾半载，各恙悉蠲。
钱塘张君篪伯令郎韵梅茂才之室，自去年夏间娩后，虽不自乳，经亦未行。方疑其劳也，四月间患感，医进
升散药，遂腹膨气逆，肢痉欲厥，或又疑其娠也。延余诊之，脉弦巅痛，乃营虚肝郁，微挟客邪，误投提表耳。
以清解轻宣之品数剂而愈，继参养荣，月事亦至，人皆诧为神治，其实非大病也。
仁和胡次瑶孝廉，北上未归，其令正于仲夏陡患肢麻昏晕，速余往视。面微红，音低神惫，睛微赤，舌苔微
黄，足微冷，身微汗，胸微闷，脉微弦。乃本元素薄，谋虑萦思，心火上炎，内风随以上僭也。不可误以为痧闭，
而妄投香燥辛散之品。以人参、龙、蛎、菖、连、石英、麦冬、小麦、竹叶、莲子心为方，两啜而愈，寻与平补
善其后。
仁和戴君文叔令嫒，年十二。患风斑睛赤，服升散药数帖，
忽觉胸次不舒，饮食下咽即吐，时作时止，医皆莫措。六、七日后，其作愈频，而有欲厥之势。所亲徐君乐亭，
嘱延余诊。脉弦而数，夜不成眠，目赤未蠲，苔黄口苦。是发斑不由外感，乃稚质阴亏，风阳上越，助以温散，
厥少陡升，肃降无权，因而吐逆。以连、柏、橘、半、栀、苑、茹、旋、海 ，少加苏叶煎送当归龙荟丸。一剂
知，二剂已。
桐乡冯诒斋广文，年二十七岁。自上年患 ，至今已十余枚，皆破而不敛，肌肉渐削，迨季夏渐形发热，而
纳食阻膈，溲短便溏，气逆嗽痰，咽喉疼肿。诸医束手，秀水庄丈芝阶荐余诊之。脉数而左寸关兼弦大，是病由
过扰心阳，兼伤谋虑，从前但从呆补，已成不治之证，近则吸受暑邪，犹日服滋填之剂，是以药造病也。而诒斋
一见倾心，坚留数日。因谓其令兄静岩赞府曰∶余仅许愈其新病也。以沙参、苡、斛、橘、半、蒿、薇、蛤壳、
浮石、茯苓，煎吞香连丸。二剂而痛泻渐止，去香连加鳖甲。又二剂而热退，改用参、苓、橘、半、苡、蛎、石
英、首乌、象牙屑、冬虫草等出入为方，卧时另制噙化丸，以肃上焦痰滞。服四帖已能起榻，眠食皆安，余遂归。
秋杪闻其没于鱼江外科家，少年博学，惜哉！余邮挽一联云∶“倾盖相知，讵成永诀；着书未竟，遽赴修文。”
知渠方注顾亭林先生《肇域志》而即病也。其夫人即于秋杪起患赤痢，延至次年春杪，证已濒危。适余游鸳湖，
往视之。昼夜三、四十行，汛断肌消，少腹素有聚瘕，跃跃而动，气冲胸下，绞痛难堪，卧不能眠，饥不能食，
口干舌绛，五热溺无，头项汗频，音低色夺，脉来细数，右软尺空。是久积忧劳，兼伤哀恸。真阴
素弱，岂可与常痢同观。以沙参、熟地、黄连、黄柏、白头翁、秦皮、冬虫夏草、枸杞、橘核、白薇，用藕、苡、
燕窝煮汤煎药，服二十剂。余游瀛洲转禾复诊，脉和痢减，安谷能眠，痛止溺行，面有华色。改用人参、熟地、
龟版、归身、黄连、黄柏、枸杞、白薇、薏苡、砂仁，以藕汤煎成，入阿胶烊服而愈。
项君香圃患赤痢濒危，所亲庄眉仙少府拉余往视。脉细不饥，口干舌绛，形消色瘁，不寐溺无。禾中医者以
其素耽曲 ，辄进苦燥渗利之药，而不闻景岳云∶酒之为害，阴虚者饮之，则伤阴也。况病因暑热，不夹湿邪，
温燥过投，阴液有立涸之虞。余将旋里，为定西洋参、生地、甘草、银花、石斛、麦冬、生白芍、扁豆花、枳
子、藕汁一方，冬瓜汤煎，令其恣服。次年春，余往禾候庄芝阶先生之疾，有一人来拜谢，面如重枣，素昧生平，
甚讶之。眉仙曰∶即香圃也，面向赤，上年因病危而色脱，故先生不识耳。承惠之方，服十余剂而愈。今又善饮
如昔矣。
角里街怡昌烛铺苏妪，年已六旬。偶患腹痛，医谓寒也，进以热剂，痛渐剧而腹胀便闭，按之甚坚，又以为
肠痈，攻之而愈痛，遂绝粒不眠，呼吸将绝。挽余诊之，脉滑而数，舌绛苔黄，口臭溺无，热阻气也。以雪羹煎
汤调益元散五钱徐灌之，即痛减气平；次日以雪羹汤送当归龙荟丸三钱，便行溺畅；随以轻清药数帖而痊。
七月中旬，余游 李归，道出梅泾，吕君慎庵拉视沈则甫令正之恙。两年前曾患滞下，嗣后便泻不已，今夏
更剧，每
晨尤甚，后重肠鸣，不饥不渴，畏热无汗，胸闷时呕，夜不成眠，形消色瘁，小溲通畅，脉软微弦，经事渐稀。
乃中虚木侮，生化无权，气久虚而血将涸矣。若刚燥则助风阳，滋腻更增滑溜，议砥柱中流，回狂澜而镇风轮。
以潞党参、山药、石脂、余粮各三钱，茯苓、白芍各一钱五分，煨诃子、橘皮各一钱，牡蛎八钱，乌梅肉炭八分，
酒炒黄柏六分，熟附子、炙甘草各五分，甘澜水煎陈米汤煮药使浓浓，徐徐细呷，俾留恋中宫，不致直下为法。
迨八月下旬，在曹霭山茂才处晤则甫云∶前方服至四剂，病即愈，今已色华能食矣。因以诗什、芽茶为赠。次年
冬，闻患寒热亡。
山妻怀孕四月，患间疟，腹痛便溏，汗多呕闷，乃痰气内滞，风暑外侵，脉滑而弦。与枳、桔、苏、连、柴、
芩、菖、夏，三剂而瘳。大女馥宜患微寒热炽，每发于夜，汛不当期而至，口渴便闭，目眩多汗，米饮不沾，暑
热为疟也，脉洪数。以知、芩、橘、半、蒿、薇、鲜斛、元参、栀子、花粉，服六剂而热减大半；去蒿、半，加
西洋参、麦冬、竹茹、枇杷叶，又六剂而便行疟止；随去元参、鲜斛，加归身调之而愈。季杰弟 室之疟，日轻
夜重，少腹觉有块，上冲则呕嗽并作，杳不进谷。余游禾归，已交八日矣。脉软以涩，是肝郁于内，暑侵其外也。
用芩、夏、翘、滑、菖、蛤、苏、连、旋、橘、丝瓜络，服六帖，诸恙霍然，随与清养善后。仲秋二十八日，余
游濮院归。是夜又陡患霍乱，腹痛异常。余起诊其脉，细数而弦，肢冷畏寒，盖覆甚浓，询其口不渴，而泻亦不
热，惟小溲全无，吐者极苦，舌色甚赤，乃新凉束暑也。玉枢丹、绛雪灌之皆不受，泻至四、五次，始觉渐热而
口大渴，仍不受饮，语言微
謇。余令捣生藕汁徐灌之，渐能受，随以芩、连、苡、楝、栀、斛、桑叶煎服，痛即减，吐泻亦止，次日知饥，
略受食，神惫已极，筋络 疼，与清养法而痊。
硖石镇蒋寅 大理令正，久患少腹聚气，时或上冲于胸而为脘痛，时或下坠而为腿肿，带多汛速，腹胀胸闷，
口腻不渴，便虽溏而欲解不行，必啖盐而始畅。皆以为脾虚，率进补剂，病日以甚。迎余诊之，脉弦滑。以栀、
芩、菖、枳、连、夏、茹、旋、雪羹清肝热以豁痰，滞气果下行至足，而胸腹渐舒。
管君幼斋令正，汛停七月，至仲秋经行不多，腹乃微胀，继则胸闷不饥，身有寒热。吕某以桂枝、黄连等药
进，而痞闷转加，二便不行，口糜而渴，得饮即吐，夜不能寐，五内如焚。余诊之，脉弦而细，面赤足冷，神惫
不支。是营阴素亏，气机多郁，郁久生热，辛燥忌投。授沙参、蒌、薤、栀、茹、旋、苑、冬瓜子、枇杷叶，二
剂而燥矢行，胸腹舒，知饥，吐止，继以宣养而瘥。其汛停良由血不足，非有血不行而阻也。
前月中旬，余过濮院，有香海寺前一妇患三疟求诊。面白唇红，舌绛而渴，寒微热盛，溲短便艰，汛事先期，
不眠，脉数，乃暑邪侵营也。与元参、丹皮、知、薇、蒿、栀、花粉、鲜斛、竹叶之方。至八月下旬，再游其地，
渠复求视，云前方服即病减，至二十剂而痊，乃子以为病后须服补药，才四帖，疟复作，遂不敢再进。余谓此必
温补方也，阅之果然。仍授清化之剂，五服而瘳。
仲秋偶觉左乳微疼，按之更甚，始知有坚核如小豆大，外微肿，即取外科药围涂，而以纸盖之，迨药干，揭
之甚痛，余不能忍。且佥云必破而不易收功，以其在乳盘之内也。余不畏死，而惧不能受此楚毒，因往求吕君慎
庵视之。曰无虑也，扫
榻款留。日以葱白寸许，嵌入梅花点舌丹一粒，旋复花三钱煎汤下；外用洄溪束毒围围之，亦以纸盖之，而药干
则自然脱落，略无粘肉伐毛之苦，此玉精炭之妙用也。凡十二日，核渐消尽。深佩吕君之德，谨录之以识其手眼
之不可及，而方药之效验，俾后人亦有所征信也。
一铁匠妇患感，杂治经旬，身热不退，不眠妄语，口渴耳聋，求治于余。脉来细数，唇红面白，肌瘦汗频。
虽是贫家，却为娇质，神虚液夺，余暑未清。以西洋参、甘草、小麦、黄连、麦冬、石斛、丹参、莲心、竹叶为
剂服之，神气遂安；自云心悸，因加红枣与紫石英，服之浃旬，竟以告愈。
九月初旬，蒋君寅 招余治其令兄仲卿孝廉夫人之病。年五十九岁。平素操持，腹有聚气，脘痛时作，大便
易溏。半月以来，身热耳聋，病泻不食，胸中痞塞，痰韧如胶，口腻欲呕，神情惫甚，脉来虚弦而细，舌苔黄腻
无津。乃营津久耗，气郁不舒，既挟客邪，过投清散，以致本实欲拨也。与参、苓、橘、半、蒌、薤、茹、连、
乙卯年冬初，我带着家眷回到故乡，在溪边选定居所。秀水的吕慎庵先生邀请我去新塍，为屠舜传的女儿（已嫁张家）看病。据家属说，这病始于产后，拖延了五年，长期卧床不起，病情发展成瘫痪，广泛服用补药，始终不见疗效。等到进屋诊视时，病人还穿着单衣，贴身只铺着草席，而窗户都紧闭着。于是询问她是怕热喜欢暗处吗？回答说：是的。切脉弦滑，拿着烛光照看，面色发红，舌苔黄腻。又问她是否有胸闷气逆的感觉？小便发热、容易出汗吗？也都回答是。而且月经仍然正常，饥饿却吃不下东西，耳鸣头晕，腿软痰多。判断病不在血分，虽然起于产后，但根源并不在此。仔细追问后，才得知在出嫁前，就有气逆眩晕的旧疾，到现在已有十年了。我说：确实如此，这是风阳内盛，煎熬津液成痰的证候，因为分娩时血液大量流失，所以发作得比较剧烈。医生不探究根本而只治疗末节，就认为是产后虚弱，随意投用温补药物，导致气机上逆更严重，下虚上实，致使不能行走。给予清火降痰的药剂后告别。我说：如果气机能向下运行，病就可以逐渐痊愈。后来听说西席钟君子安对吕慎庵说：服用了我的药五帖，就能拄着拐杖出门了。
屠舜传的舅嫂，因为用力拔针而导致手指疼痛，内外杂治，渐渐发展到全身疼痛，卧床不起，饮食减少，形体消瘦。我诊察她，脉细数，口干舌绛。这是营阴大亏，无法营养筋骨。怎么能因为拔针致病，就认为是外伤而胡乱投用燥烈之药呢？难怪病情日益加重。用集灵膏加减作为方剂治愈了她。
谢再华先生的妻子，偶然患牙痛，一天比一天严重，到第五天，知道我在武林游玩，便拉我去诊治，此时她已经呻吟欲绝，浑身肌肉颤抖，切脉不准，问病不能回答，舌苔颜色看不清，只想用冷器贴在疼痛处。我深思良久，让她用淡盐水送服滋肾丸三钱；外用坎宫锭涂抹疼痛外部，吴茱萸粉末醋调敷贴涌泉穴。第二天复诊，已经谈笑自若，像往常一样做针线活了。向我致谢说：昨天喝了一服药就睡着了，病好像消失了，真是仙丹啊。我对他说：昨天情况非常窘迫，如果不是素知你是肝阳内盛的体质，几乎无处下手。现在火气虽然下降，脉象还是弦数，应该用滋阴潜阳的方法善后。用一贯煎方，嘱咐她熬膏服用，于是没有再复发。
仁和邵位西枢密使的女儿，字许子双司马的儿媳，在京城患心悸头晕，渐渐不能起床，进而不能说话。回杭州后，多位医生治疗，都认为属虚证，广泛服用补药，结果导致进食减少睡眠少，频繁呕吐痰涎，怕风怕烦，小便短少大便闭塞，月经失调白带增多，认为活不过冬至了。恰逢我在武林游玩，赵菊斋先生嘱咐邀请我去诊治。切脉弦数而滑，面白唇红，目光炯炯但皱眉畏光，舌苔黄且乳头状裂纹，既不是失语症，也不是失音，强行让她发出一两个字，则异常艰难，摇手点头，或用笔代替说话，也没有幻觉妄见，不是鬼神作祟。我仔细审视，认为必定起于惊恐，痰涎阻塞窍道。病人点头表示同意。追溯发病原因，是因为一个大瓶子突然落地，乍闻其声受到惊吓所致。于是给予清心肝胆胃的方法，加入舒络涤痰开郁的药物。服用后各症状逐渐减轻，睡眠饮食逐渐安稳。丙辰年春天，我再去看望她。仍然卧床，仍然不说话。引用钮琇《续觚剩》中“鼠魂”一条，与此相似，那只是神化说法罢了。然而我竟然不能治好她让她说话，深感惭愧，记录下来以请教高明人士。戊午年深秋，再次去武林就诊，状况依然如故。听说她仍在服用补药，因此极力劝阻，并赠送清肺通络涤痰的药物，制成丸药含化。服用到次年春仲，遍身发疹，频繁吐出秽浊痰液，言语能逐渐说出，这是蕴结之邪从外解除了，从此整顿肃清，可以期待见效，最初的诊断尚不完全透彻。
丙辰年初春，我在梅泾游玩，曹霭山秀才邀请我看他儿子的病。说是去年夏天疟疾之后开始的，傍晚发热流鼻血，喜欢打哈欠畏光，额颊时而麻木，小便浑浊伴有脚肿。禀赋本来虚弱，大家都担心变成劳损，频繁服用滋补填精的药，毫无效果，长期不能起床。等我诊察时，脉软滑而微长，舌淡黄而不渴，只能仰卧，翻身困难。我说：这不是虚劳，而是热伏阳明经，所以关节不利，筋骨不束，出现以上诸证。幸好鼻血频繁流出，小便浑浊，热气尚有宣泄途径，而且人没有极度枯瘦，因为阳明经是多气多血的经脉。给予生槐蕊、知母、黄柏、黄芩、栀子、白薇、花粉、茅根、竹茹、石斛、丝瓜络等药，久服果然逐渐痊愈。
乡里张雪沂先生的正室，三十七岁。在乙巳年患经期腹痛，医生进服胶艾汤多剂，疼痛反而日益加重，加上呕吐，至今十年，各种药都试过了。近年月经来潮越来越频繁，疼痛更加剧烈，在床上乱滚，声音传到邻居那里。请求我诊治，脉弦滑而数。我问：头痛吗？口渴吗？带下多吗？腰痛吗？经血色紫黑吗？病人惊讶以为我是神医，惨白的脸色舒展了一些。我对雪沂说：这个证候不但温燥腻补不可用，就是四物汤也在禁忌之列。难怪遍访妇科医生，竟无一人有效。给予黄芩、黄连、栀子、胆南星、竹茹、黄柏、青蒿、白薇、乌贼骨、茅根、藕节为方剂，服用到下个月经来潮时，就不呕吐了，疼痛也大大减轻。这类药服用超过半年，各种病症全部消除。
钱塘张篪伯秀才的儿子韵梅茂才的妻子，自去年夏天分娩后，虽然不自喂母乳，月经也未行。方才怀疑是虚劳，四月间患感冒，医生进服升散药，于是腹部膨隆气逆，肢体痉挛欲昏厥，有人又怀疑是怀孕。请我去诊治，脉弦巅顶痛，这是营血虚肝气郁结，微挟外邪，误用提表药所致。用清解轻宣的药物几剂而愈，随后参入养荣汤，月经也来了，人们都惊诧为神治，其实并不是大病。
仁和胡次瑶孝廉，北上未归，他的正室在仲夏突然患肢体麻木昏晕，急忙请我去看。面微红，声音低精神疲惫，眼睛微赤，舌苔微黄，脚微冷，身体微汗，胸部微闷，脉微弦。这是本身体质薄弱，谋虑萦绕思考，心火上炎，内风随之上僭。不可误以为是痧闭，而胡乱投用香燥辛散的药物。用人参、龙骨、牡蛎、石菖蒲、黄连、紫石英、麦冬、小麦、竹叶、莲子心为方剂，喝两次而愈，随后用平补法善后。
仁和戴文叔先生的女儿，十二岁。患风斑眼睛红，服用升散药几帖，忽然觉得胸中不适，饮食咽下即吐，时作时止，医生都无计可施。六、七日后，发作更频繁，且有欲昏厥的趋势。亲戚徐乐亭先生，嘱咐延请我去诊治。脉弦数，夜里不能睡觉，眼睛红未消，舌苔黄口苦。这是发斑不由外感，而是幼童体质阴亏，风阳上越，助以温散药，厥阴少阳之气陡升，肃降无权，因而呕吐逆气。用黄连、黄柏、橘皮、半夏、栀子、瓜蒌仁、竹茹、旋覆花、海浮石，稍加苏叶煎汤送服当归龙荟丸。一剂见效，二剂痊愈。
桐乡冯诒斋广文，二十七岁。从去年患疮疡，至今已十余枚，都破溃不收敛，肌肉逐渐消瘦，等到季夏渐渐发热，且进食受阻膈塞，小便短少大便溏泄，气逆咳嗽有痰，咽喉肿痛。各位医生束手无策，秀水庄芝阶丈推荐我去诊治。脉数而左寸关兼弦大，这是病由过度扰动心阳，兼伤谋虑，从前只从呆补入手，已成不治之证，近来又吸受暑邪，还每日服用滋补填精之剂，是以药造病。而诒斋一见倾心，坚决挽留数日。于是对他哥哥静岩赞府说：我只答应治好他的新病。用沙参、薏苡仁、石斛、橘皮、半夏、青蒿、白薇、蛤壳、浮石、茯苓，煎汤吞服香连丸。两剂后痛泻渐止，去掉香连丸加入鳖甲。又两剂后热退，改用人参、茯苓、橘皮、半夏、薏苡仁、牡蛎、紫石英、何首乌、象牙屑、冬虫夏草等出入组方，睡前另制含化丸，以肃清上焦痰滞。服用四帖已能起床，睡眠饮食皆安，我便回去了。秋末听说他在鱼江外科家中去世，少年博学，可惜啊！我寄去挽联说：“倾盖相知，讵成永诀；着书未竟，遽赴修文。”知道他正在注释顾亭林先生的《肇域志》时就病了。他的夫人就在秋末患上赤痢，拖延到次年春末，病情已濒危。恰逢我在鸳湖游玩，前往探望。昼夜排便三、四十次，月经断绝肌肉消瘦，少腹素有积聚瘕块，跃跃而动，气冲胸下，绞痛难忍，卧床不能眠，饥饿不能吃，口干舌绛，五心烦热尿无，头项汗频，声音低神色衰败，脉来细数，右脉软尺部空。这是久积忧劳，兼伤哀恸。真阴素弱，怎能与普通痢疾同论。用沙参、熟地、黄连、黄柏、白头翁、秦皮、冬虫夏草、枸杞、橘核、白薇，用藕、薏苡仁、燕窝煮汤煎药，服用二十剂。我在瀛洲转禾复诊，脉和痢减，能吃饭能睡觉，痛止尿行，面色红润。改用人参、熟地、龟版、当归身、黄连、黄柏、枸杞、白薇、薏苡仁、砂仁，用藕汤煎成，加入阿胶烊化服用而愈。
项香圃患赤痢濒危，亲戚庄眉仙少府拉我去看。脉细不饥，口干舌绛，形体消瘦面色憔悴，不寐尿无。嘉兴中医因为他平时贪恋酒曲，就进服苦燥渗利之药，却不听景岳先生说：酒之为害，阴虚者饮之，则伤阴也。何况病因暑热，不夹湿邪，温燥过投，阴液有立即枯竭的危险。我将要回乡，为他定西洋参、生地、甘草、银花、石斛、麦冬、生白芍、扁豆花、枳子、藕汁一方，冬瓜汤煎，让他尽情服用。次年春天，我去嘉兴等候庄芝阶先生的病，有一人来拜谢，面如重枣，素不相识，很惊讶。眉仙说：就是香圃啊，脸向来红，上年因病危而色脱，所以先生不认识罢了。承蒙惠赐方子，服用十余剂而愈。现在又像以前一样善饮酒了。
角里街怡昌烛铺苏老太婆，六十多岁。偶然患腹痛，医生说是寒证，进服热剂，疼痛逐渐加剧且腹胀便秘，按之很硬，又以为是肠痈，攻下治疗后疼痛更甚，于是绝食不眠，呼吸将绝。请我去诊治，脉滑数，舌绛苔黄，口臭尿无，热阻气机。用雪羹煎汤调益元散五钱慢慢灌服，即疼痛减轻气息平稳；次日用雪羹汤送服当归龙荟丸三钱，大便通小便畅；随后用轻清药物几帖而痊愈。
七月下旬，我在李归游玩，路过梅泾，吕慎庵先生拉我去看沈则甫先生的正室之病。两年前曾患痢疾，此后便泻不止，今年夏天更严重，每晨尤其厉害，里急后重肠鸣，不饥不渴，怕热无汗，胸闷时呕，夜里不能睡觉，形体消瘦面色憔悴，小便通畅，脉软微弦，月经逐渐稀少。这是中气虚木气侮脾，生化无权，气久虚而血将枯竭。如果用刚燥药则助风阳，滋腻药更增滑溜，议定砥柱中流，回狂澜而镇风轮。用潞党参、山药、赤石脂、禹余粮各三钱，茯苓、白芍各一钱五分，煨诃子、橘皮各一钱，牡蛎八钱，乌梅肉炭八分，酒炒黄柏六分，熟附子、炙甘草各五分，甘澜水煎陈米汤煮药使其浓稠，慢慢细细呷服，以使药力留恋中焦脾胃，不致直下肠道为法。等到八月下旬，在曹霭山秀才处遇见则甫说：前方服用至四剂，病即愈，现在已经面色红润能吃东西了。于是赠诗和芽茶。次年冬天，听说患寒热病去世。
我的妻子怀孕四个月，患间日疟，腹痛便溏，汗多呕闷，这是痰气内滞，风暑外侵，脉滑而弦。用枳壳、桔梗、苏叶、黄连、柴胡、黄芩、石菖蒲、半夏，三剂而病愈。大女馥宜患微寒热炽盛，每发于夜间，月经不当期而至，口渴便秘，目眩多汗，米饮不进，暑热为疟，脉洪数。用知母、黄芩、橘皮、半夏、青蒿、白薇、鲜石斛、玄参、栀子、花粉，服用六剂热减大半；去掉青蒿、半夏，加西洋参、麦冬、竹茹、枇杷叶，又六剂大便通疟止；随后去掉玄参、鲜石斛，加当归身调理而愈。季杰弟弟的妻子的疟疾，日轻夜重，少腹觉有块，上冲则呕吐咳嗽并作，完全不吃谷食。我从嘉兴回来，已经过了八天了。脉软以涩，这是肝郁于内，暑侵其外。用黄芩、半夏、连翘、滑石、石菖蒲、蛤壳、苏叶、黄连、旋覆花、橘皮、丝瓜络，服用六帖，各种病症霍然痊愈，随后用清养法善后。仲秋二十八日，我从濮院回来。当晚又突然患霍乱，腹痛异常。我起来诊脉，细数而弦，肢冷畏寒，盖得很厚，询问口不渴，而泻也不热，只有小便全无，呕吐极苦，舌色很赤，这是新凉束暑。玉枢丹、绛雪灌服都不受，泻至四、五次，才觉得渐热而口大渴，仍不接受饮水，语言微蹇。我令捣生藕汁慢慢灌服，渐能接受，随后用黄芩、黄连、薏苡仁、川楝子、栀子、石斛、桑叶煎服，疼痛即减，吐泻亦止，第二天知道饿了，略受食，精神疲惫已极，筋络疼痛，用清养法而痊愈。
硖石镇蒋寅大理的正室，久患少腹聚气，时而上冲于胸而为脘痛，时而下坠而为腿肿，带下多月经快，腹胀胸闷，口腻不渴，大便虽溏但想解解不出，必须吃盐才能通畅。都认为是脾虚，率先进补药，病情日益加重。迎我去诊治，脉弦滑。用栀子、黄芩、石菖蒲、枳壳、黄连、半夏、竹茹、旋覆花、雪羹清肝热以豁痰，滞气果下行至足，而胸腹渐舒。
管幼斋先生的正室，月经停七月，到仲秋经行不多，腹部乃微胀，继则胸闷不饥，身体有寒热。吕某用桂枝、黄连等药进服，而痞闷转加，二便不行，口糜而渴，得饮即吐，夜里不能睡觉，五脏如火烧。我诊脉弦而细，面赤足冷，精神疲惫不堪。这是营阴素亏，气机多郁，郁久生热，辛燥忌投。授沙参、瓜蒌、薤白、栀子、竹茹、旋覆花、瓜蒌仁、冬瓜子、枇杷叶，二剂后燥屎行，胸腹舒，知饥，吐止，继以宣养而病愈。其月经停良由血不足，并非有血不行而阻也。
前月中旬，我经过濮院，有香海寺前一妇人患三日疟求诊。面白唇红，舌绛而渴，寒微热盛，小便短少大便艰难，月经事先期，不眠，脉数，这是暑邪侵营。用玄参、丹皮、知母、白薇、青蒿、栀子、花粉、鲜石斛、竹叶之方。到八月下旬，再次游历其地，她又请求诊治，说前方服用即病减，至二十剂而痊愈，但她儿子认为病后须服补药，才四帖，疟疾复发，遂不敢再进。我说这必定是温补方，查看果然如此。仍授清化之剂，五服而病愈。
仲秋偶然觉得左乳微疼，按之更甚，始知有坚核如小豆大，外微肿，即取外科药围涂，而以纸盖之，等到药干，揭开很痛，我不能忍受。况且大家都说必破而不易收功，因为它在乳盘之内。我不怕死，而惧不能受此楚毒，于是去求吕慎庵先生诊治。说不要忧虑，扫榻款留。每天以葱白寸许，嵌入梅花点舌丹一粒，旋复花三钱煎汤送下；外用洄溪束毒围围之，也以纸盖之，而药干则自然脱落，略无粘肉伐毛之苦，这是玉精炭的妙用。凡十二日，核渐消尽。深深佩服吕先生的德行，谨记录以识别其手段之不可及，以及方药之效验，使后人也有所征信。
一铁匠妇患感冒，杂治经旬，身热不退，不眠妄语，口渴耳聋，求治于我。脉来细数，唇红面白，肌瘦汗频。虽是贫家，却是娇贵体质，神虚液夺，余暑未清。用西洋参、甘草、小麦、黄连、麦冬、石斛、丹参、莲心、竹叶为剂服用，神气遂安；自云心悸，因加红枣与紫石英，服用十天，竟以此告愈。
九月初旬，蒋寅招我去治他哥哥仲卿孝廉夫人的病。五十九岁。平素操持家务，腹有聚气，脘痛时作，大便易溏。半月以来，身热耳聋，病泻不食，胸中痞塞，痰韧如胶，口腻欲呕，神情疲惫甚，脉来虚弦而细，舌苔黄腻无津。这是营津久耗，气郁不舒，既挟客邪，过投清散，以致本实欲拨。用党参、茯苓、橘皮、半夏、瓜蒌、薤白、竹茹、黄连……
In the early winter of the Yimao year, I returned to my hometown with my family and settled by the stream. Mr. Lv Shen'an from Xiushui invited me to Xincheng to examine the daughter of Tu Shunchuan (who had married into the Zhang family). According to her family, the illness began postpartum and had persisted for five years. She had been bedridden for a long time, developing paralysis, and had widely taken tonic preparations without effect. Upon entering the room to examine her, the patient was still wearing thin clothing, with only a straw mat beneath her, and all windows were tightly shut. I asked if she feared heat and preferred darkness; she replied in the affirmative. Her pulse was wiry and slippery. Illuminating with a candle, her face appeared red, and her tongue coating was yellow and greasy. I further asked if she experienced chest fullness and rising qi, hot urination, and easy sweating; she confirmed these as well. Additionally, her menstruation continued normally, yet she felt hungry but could not eat, suffered from tinnitus and dizziness, weak legs, and excessive phlegm. The disease did not reside in the Blood aspect; although it originated postpartum, its root lay elsewhere. After careful inquiry, she revealed that before marriage, she had suffered from chronic qi rebellion and vertigo for ten years. I said: "Indeed, this is a pattern of internal blazing Wind-Yang, scorching fluids to form Phlegm. Because of the massive blood loss during childbirth, the condition manifested severely. Physicians failed to investigate the root and treated only the branches, assuming postpartum deficiency, and indiscriminately administered warming tonics. This exacerbated the rebellious Qi, leading to deficiency below and excess above, resulting in immobility." I prescribed decoctions to clear Fire and descend Phlegm, then departed, saying: "If the Qi can descend, the illness will gradually improve." Later, I heard Zhong Zi'an, a tutor, tell Lv Shen'an: "After taking Dr. Wang's medicine for five doses, she could walk out leaning on a cane."
Tu Shunchuan's brother-in-law's wife suffered finger pain due to forceful needle removal. Despite various internal and external treatments, the pain spread throughout her body, confining her to bed, with reduced appetite and emaciation. My examination revealed a fine and rapid pulse, dry mouth, and a crimson tongue. This indicated severe depletion of Ying-Yin, unable to nourish the sinews and bones. How could one attribute this solely to external trauma from needle removal and recklessly administer drying and acrid-hot medicines? No wonder the condition worsened daily. I cured her using modified Jiling Gao (Cistanche Pill).
Mrs. Xie Zaihua occasionally suffered from toothache, which intensified daily. By the fifth day, knowing I was in Wulin, she summoned me. She was groaning near death, trembling all over, with an unmeasurable pulse, inability to answer questions, and unclear tongue coating. She desired to apply cold objects to the painful area. After deep contemplation, I instructed her to swallow San Qian of Zishen Wan (Kidney Nourishing Pill) with light salt water; externally, I applied Kangong Ding (Kangong Ointment) to the painful area and pasted Wu Zhu Yu powder mixed with vinegar onto Yongquan (KI-1). On the second day's follow-up, she was chatting calmly, resuming needlework as usual. She thanked me, saying: "Yesterday, after one drink of medicine, I slept, and the illness vanished like magic; truly a fairy pill." I replied: "Yesterday was extremely difficult. Had I not known your constitution of internal blazing Liver-Yang, I would have been at a loss. Although the Fire has subsided, the pulse remains wiry and rapid. You should use Yin-nourishing and Yang-subduing methods for recovery." I prescribed Yi Guan Jian (One Decoction), advising her to take it as a paste, preventing recurrence.
The daughter of Shao Weixi, a Privy Councilor from Renhe, married to Sima Xu Zishuang, suffered palpitations and dizziness in the capital, gradually becoming bedridden and mute. Upon returning to Hangzhou, multiple physicians treated her, all diagnosing deficiency and administering widespread tonics. This led to reduced intake and sleep, frequent vomiting of saliva/phlegm, aversion to wind and annoyance, short urine, constipation, irregular menstruation, and heavy leukorrhea. They believed she would not survive until Winter Solstice. Coinciding with my visit to Wulin, Zhao Juzhai requested my consultation. Her pulse was wiry, rapid, and slippery; her face was pale with red lips, eyes bright but frowning against light, and tongue coating yellow with fissures. It was neither aphasia nor mutism. Forcing one or two words resulted in extreme difficulty; she shook her head, nodded, or used a pen to communicate, with no hallucinations, ruling out demonic influence. Careful examination suggested onset due to fright, with Phlegm-saliva blocking the orifices. The patient agreed. Tracing back, a large bottle had fallen suddenly, causing a startle. I prescribed methods to clear Heart, Liver, Gallbladder, and Stomach, adding herbs to soothe collaterals, wash away Phlegm, and relieve depression. Symptoms gradually subsided, and sleep/appetite improved. In spring of Bingchen year, upon re-examination, she remained bedridden and mute. Referencing Niu Xiu's *Xu Gu Sheng* ("Rat Soul" entry), which resembled this case but was mystified, I admitted my inability to restore her speech, feeling ashamed, and recorded it for expert advice. In late autumn of Wuwu year, visiting again, her condition remained unchanged. Hearing she still took tonics, I strongly advised against it and gifted pills for clearing Lung, unblocking collaterals, and washing Phlegm. By mid-spring of the following year, she broke out in rashes and vomited turbid phlegm frequently, gradually regaining speech. This indicated trapped pathogens resolving outwardly. From then on, recovery was expected, though my initial diagnosis was not entirely precise.
In early spring of Bingchen year, while in Meijing, Scholar Cao Aishan invited me to see his son. The illness started after summer malaria last year: evening fever, epistaxis, yawning, photophobia, numbness of forehead/cheeks, turbid urine, and swollen feet. Given his weak constitution, everyone feared consumptive disease and frequently administered yin-nourishing tonics with no effect, leaving him bedridden. My examination showed a soft, slippery, slightly long pulse; pale yellow tongue coating without thirst; able only to lie supine, unable to turn. I said: "This is not consumptive disease, but Heat latent in the Yangming channel, causing joint dysfunction and lack of sinew/bone binding, presenting as above. Fortunately, frequent epistaxis and turbid urine indicate heat expulsion, and he is not severely emaciated because Yangming is a channel abundant in Qi and Blood." I prescribed Sheng Huairui, Zhimu, Huangbai, Huangqin, Zhizi, Baiwei, Huafen, Maogen, Zhuru, Shihu, and Sigualuo. Long-term use led to gradual recovery.
Mrs. Zhang Xueyi, aged 37, suffered dysmenorrhea starting in Yisi year. Multiple doses of Jiao'ai Tang increased pain and induced vomiting. Over ten years, she tried all medicines. Recently, menstruation became more frequent, pain more severe, rolling on the bed, screaming audible to neighbors. Pulse was wiry, slippery, and rapid. I asked: Cephalalgia? Thirst? Heavy leukorrhea? Lumbago? Dark purple/black menstrual blood? She was amazed, thinking me divine, and her grimace softened. I told Xueyi: "For this pattern, warming-drying and cloying tonics are contraindicated; even Siwu Tang is forbidden. No wonder gynecologists failed." I prescribed Huangqin, Lian, Zhizi, Danni, Zhuru, Huangbai, Qinghao, Baiwei, Wumei, Maogen, and Ou. By next menstruation, vomiting ceased, and pain greatly reduced. Taking these herbs for over half a year eliminated all symptoms.
Mrs. Yunmei, wife of Liangcai Rongmei, son of Zhang Chibo from Qiantang, had not menstruated since summer delivery last year, despite not breastfeeding. Suspected deficiency, she contracted a cold in April. Physicians administered lifting/dispersing drugs, causing abdominal distension, rebellious Qi, limb spasms, and syncope. Others suspected pregnancy. My examination showed wiry pulse and vertex headache. This was Ying-blood deficiency with Liver depression, slight exterior pathogen, mismanaged by surface-lifting drugs. Several doses of clearing/resolving and light-dispersing herbs cured her. Subsequent Yangrong supplementation restored menstruation. People marveled at the miraculous cure, but it was not a major disease.
Hu Ciyao, a Jinshi from Renhe, was away in the north. His wife suddenly suffered limb numbness and vertigo in mid-summer. Examination: slightly red face, low voice, fatigue, slightly red eyes, pale yellow tongue coating, cold feet, slight sweat, mild chest stuffiness, wiry pulse. Constitution was originally weak, burdened by worry/thoughts, causing Heart-Fire flaming upward and internal Wind rising. Do not mistake for Sha-closure or recklessly use aromatic-drying/acrid-dispersing drugs. Prescription: Renshen, Longgu, Muli, Shichangpu, Lian, Shiying, Maidong, Xiaomai, Zhuye, Lianzixin. Two doses cured her; followed by mild tonification.
Dai Wenshu's daughter, aged 12, suffered wind-rash and red eyes. After several doses of lifting/dispersing drugs, she suddenly felt chest discomfort, immediate vomiting after swallowing food, intermittent. Doctors were helpless. After six-seven days, frequency increased, approaching syncope. Relative Xu Leting requested my consultation. Pulse wiry and rapid, insomnia, persistent red eyes, yellow coating, bitter taste. Rash was not from exterior contraction but from childhood Yin deficiency with Wind-Yang floating up. Warming dispersants aggravated Jue-Shaoyang, impairing descending function, causing vomiting. Prescription: Lian, Bai, Ju, Ban, Zhi, Yuan, Ru, Xuan, Haifushi, with少许 Suye decocted to deliver Danggui Longhui Wan. One dose effective, two doses cured.
Feng Yizhai, a scholar from Tongxiang, aged 27. Since last year, suffered from sores, now over ten, ulcerated and non-healing, with muscle wasting. By late summer, fever developed, dysphagia, short urine, loose stool, rebellious Qi, cough with phlegm, sore throat/swelling. Doctors were helpless. Zhuang Zhijie recommended me. Pulse rapid, left Cun/Guan wiry and large. Illness caused by excessive disturbance of Heart-Yang and mental strain. Previous treatment relied on static tonification, rendering it incurable. Recent summer-heat invasion combined with continued yin-tonics created iatrogenic disease. Feng insisted I stay. I told his brother Jingyan: "I only promise to cure the new illness." Prescription: Shashen, Yiyiren, Shihu, Ju, Ban, Qinghao, Baiwei, Geqiao, Fusshi, Fuling, decocted to swallow Xianglian Wan. Two doses stopped pain/diarrhea; removed Xianglian, added Biejia. Two more doses reduced fever; switched to Renshen, Fuling, Ju, Ban, Yiyiren, Muli, Shiying, Shouwu, Xiangyasui, Dongchongxiacao. Bedtime pills cleared upper Jiao Phlegm-stasis. Four doses allowed getting up, normal sleep/appetite, then I returned. Late autumn, heard he died at a surgeon's home. Regrettable! Sent couplet: "Acquaintance turned to eternal parting; unfinished books, sudden call to literary service." He was annotating Gu Tinglin's *Zhaoyuzhi* when ill. His wife also got bloody dysentery in late autumn, worsening to spring. Visiting Yuanhu, she had 30-40 stools/day, amenorrhea, emaciation, active abdominal mass, Qi rushing to chest, unbearable colic, insomnia, anorexia, dry mouth/crimson tongue, five-palm heat, anuria, head/neck sweating, low voice/pale color, fine/rapid pulse, right soft/kidney empty. Chronic worry/labor plus grief. True Yin weak, unlike common dysentery. Prescription: Shashen, Shudi, Huanglian, Huangbai, Baitouweng, Qinpi, Dongchongxiacao, Gouqi, Juhe, Baiwei, decocted in Ou/Yiyiren/Yanwo soup. Twenty doses. Follow-up in He: pulse harmonized, dysentery reduced, eating/sleeping restored, pain/anuria resolved, complexion glowing. Changed to Renshen, Shudi, Guiban, Danggui, Huanglian, Huangbai, Gouqi, Baiwei, Yiyiren, Sharen, decocted in Ou soup, dissolved Ejiao. Cured.
Xiang Xiangpu, critically ill with bloody dysentery. Relative Zhuang Mixian requested consultation. Fine pulse, anorexia, dry mouth/crimson tongue, emaciation/fatigue, insomnia/anuria. Jiaxing doctors, noting alcohol indulgence, used bitter-drying/diuretic drugs, ignoring Jingyue's warning: "Alcohol harms Yin; drinking damages Yin in Yin-deficient persons." Etiology was summer-heat without dampness; excessive drying threatened total Yin collapse. Before leaving, I prescribed Xiyangshen, Shengdi, Gancao, Yinhua, Shihu, Maidong, Sheng Baishao, Biandouhua, Zhizi, Ouji, decocted in winter melon soup, to be taken freely. Next spring, waiting for Zhuang Zhijie in Jiaxing, a man greeted me with a red face, unknown to me. Mixian said: "It's Xiangpu. He was always red-faced; last year illness caused pallor, hence unrecognized. Your prescription cured him in ten doses. Now he drinks as before."
Su, elderly woman from Yichang Candle Shop, aged 60. Occasional abdominal pain. Doctor diagnosed Cold, gave hot drugs. Pain worsened, abdominal distension/constipation, hard on palpation. Diagnosed as intestinal abscess, attacked with purgatives, pain increased. Starvation/inspiration, breathing nearly ceased. Consultation: Slippery/rapid pulse, crimson tongue/yellow coating, bad breath/anuria. Heat obstructing Qi. Snow Broth decocted to mix with YiYuan San (5 qian), slowly灌ed. Pain/Qi normalized next day. Snow Broth delivered Danggui Longhui Wan (3 qian); bowel/bladder unblocked. Light-clearing herbs completed cure.
Mid-July, traveling Li Gui via Meijing, Lv Shen'an invited me to see Shen Zefu's wife. Two years ago, dysentery; thereafter chronic diarrhea, worse this summer, mornings especially. Tenesmus, borborygmus, anorexia, no thirst, fear of heat/no sweat, chest fullness/vomiting, insomnia, emaciation/pallor, free urination, soft/wiry pulse, sparse menstruation. Middle-Jiao deficiency with Wood insulting Earth, failure of transformation/transportation. Qi deficiency leading to Blood exhaustion. Acrid-hot aids Wind-Yang; cloying increases slipping. Strategy: Stabilize center, calm Wind-wheel. Prescription: Ludangshen, Shanyao, Shizhi, Yuliang each 3 qian; Fuling, Baishao 1.5 qian; Wei Hezi, Jupi 1 qian; Muli 8 qian; Wumei carbon 0.8 fen; Jiuhuangbai 0.6 fen; Shufuzi, Zhigancao 0.5 fen. Decocted in Ganlan water with thick Chenmi soup, sipped slowly to retain in Middle Jiao. Late August, met Zefu: four doses cured, healthy/eating. Gifted poetry/tea. Next winter, heard he died of chills/fever.
My wife, pregnant four months, suffered tertian malaria, abdominal pain, loose stool, profuse sweat, nausea/chest oppression. Phlegm-Qi stagnation internally, Wind-Heat externally. Slippery/wiry pulse. Prescription: Zhike, Jiegeng, Sue, Lian, Chai, Qin, Changpu, Ban. Three doses cured. Eldest daughter Fuyi: mild chills/high fever, nocturnal onset, premature menstruation, thirst, constipation, vertigo, sweating, anorexia. Summer-heat malaria.洪数 pulse. Prescription: Zhimu, Qin, Ju, Ban, Qinghao, Baiwei, Xian Shihu, Xuanshen, Zhizi, Huafen. Six doses halved fever; removed Qinghao/Ban, added Xiyangshen, Maidong, Zhuru, Pipaye. Six more doses bowel movement/malaria cessation; removed Xuanshen/Xian Shihu, added Danggui. Cured. Brother Jijie's wife: Malaria, lighter by day/heavier by night, lower abdominal mass, rising Qi causing vomiting/cough, anorexia. Returned from Jiaxing after eight days. Soft/rough pulse. Liver depression internally, summer-heat externally. Prescription: Qin, Ban, Qiaohua, Huashi, Changpu, Geqiao, Su, Lian, Xuan, Ju, Sigualuo. Six doses complete resolution; followed by clearing/nourishing.
Late Zhongqiu (Aug 28), returning from Puyuan, sudden cholera-like disorder, severe abdominal pain. Pulse fine/rapid/wiry, cold limbs/aversion to cold, heavy quilts, no thirst, non-hot diarrhea, anuria, bitter vomiting, crimson tongue. New coolness binding summer-heat. Yushu Dan/Jiangxue refused. After 4-5 diarrheas, felt warm, extreme thirst, refused drink, slurred speech. Crushed fresh Ou juice slowly灌ed; accepted. Then Qin, Lian, Yiyiren, Chuanlianzhong, Zhizi, Shihu, Sangye. Pain reduced, vomiting/diarrhea stopped. Next day hunger returned, slight intake, extreme fatigue, meridian pain. Clearing/nourishing method cured.
Jiang Yin, Dalishi's wife from Xiashi town: Chronic lower abdominal Qi accumulation, rising to chest causing epigastric pain, falling to legs causing edema, heavy leukorrhea, rapid menstruation, abdominal/chest fullness, sticky mouth/no thirst, loose stool but difficult defecation, relieved only by salt. Diagnosed Spleen deficiency, given tonics, worsened. Pulse wiry/slippery. Prescription: Zhizi, Qin, Changpu, Zhike, Lian, Ban, Ru, Xuan, Xue Geng. Clear Liver Heat, resolve Phlegm. Stagnant Qi descended to feet, chest/abdomen relaxed.
Guan Youzhai's wife: Amenorrhea seven months. Mid-autumn, light menstruation, mild abdominal distension, chest fullness/anorexia, alternating chills/fever. Lv used Guizhi, Huanglian, etc., worsening obstruction, constipation/urinary retention, oral ulcers/thirst, vomiting after drinking, insomnia, burning internal organs. Pulse wiry/fine, red face/cold feet, fatigue. Ying-Yin deficiency, Qi stagnation, prolonged stagnation generating Heat. Avoid acrid-hot. Prescription: Shashen, Lou, Xie, Zhizi, Ru, Xuan, Yuan, Dongguazi, Pipaye. Two doses: dry stool passed, chest/abdomen relaxed, hunger returned, vomiting stopped; followed by dispersing/nourishing. Amenorrhea due to Blood insufficiency, not blockage.
Mid-month, passing Puyuan, woman from Xianghai Temple suffered tertian malaria. Pale face/red lips, crimson tongue/thirst, mild chills/high fever, short urine/hard stool, early menstruation, insomnia, rapid pulse. Summer-heat invading Ying. Prescription: Xuanshen, Danpi, Zhimu, Baiwei, Qinghao, Zhizi, Huafen, Xian Shihu, Zhuye. Late August, revisited. Patient said previous formula worked, cured in 20 doses. Son insisted on post-illness tonics; took four doses, malaria recurred, refused further. I suspected warming tonics; confirmed. Prescribed clearing/transformation agents. Five doses cured.
Zhongqiu: Left breast slight pain, worse on pressure. Hard nodule, bean-sized, slight swelling. Applied surgical paste, covered with paper. When dry, peeling was painful. Everyone said rupture inevitable, hard to heal due to location. Feared torture, sought Lv Shen'an. Advice: No worry. Daily: Scallion white (1 cun) embedded with Meihua Dianshe Dan pill, delivered with Xuanfuhua decoction. External: Huixi Shudu Wei. Covered with paper, fell off naturally when dry, no flesh-hair damage. Jade Essence Charcoal efficacy. Twelve days, nodule disappeared. Deeply admire Lv's virtue/skill, record for posterity.
Blacksmith's wife: Cold, miscured for ten days. Persistent fever, insomnia/confabulation, thirst/deafness. Fine/rapid pulse, red lips/pale face, emaciation/sweating. Poor but delicate constitution, Spirit/Qi deficiency, fluid depletion, lingering summer-heat. Prescription: Xiyangshen, Gancao, Xiaomai, Huanglian, Maidong, Shihu, Danshen, Lianxin, Zhuye. Spirit/Qi stabilized; added Hongzao, Zi Shiyin for palpitations. Ten days, cured.
Early September, Jiang Yin invited me to treat brother Zhongqing's wife, Jinshi, aged 59. Habitual labor, abdominal Qi mass, episodic epigastric pain, loose stool. Half month: fever/deafness, diarrhea/anorexia, chest oppression, tough phlegm, sticky mouth/nausea, extreme fatigue, deficient/wiry/fine pulse, yellow/greasy dry tongue coating. Ying-fluid depleted, Qi stagnation, exterior pathogen, excessive clearing/dispersing damaging root. Prescription: Renshen, Fuling, Ju, Ban, Lou, Xie, Ru, Lian...